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The Messinian salinity crisis and its precursor events have been the greatest environmental perturbation of the Mediterranean Sea to date, offering an opportunity to study the response of marine ecosystems to extreme hydrological change and a large-scale biological invasion. The restriction of the marine connection between the Mediterranean and the Atlantic Ocean resulted in stratification of the water column and high-amplitude variations in seawater temperature and salinity already from the early Messinian. Here, we present a unified and revised marine fossil record of the Mediterranean (https://doi.org/10.5281/zenodo.13358435, Agiadi et al., 2024) that covers the Tortonian stage, the pre-evaporitic Messinian stage, and the Zanclean stage and encompasses 23 032 occurrences of calcareous nannoplankton, dinoflagellates, foraminifera, corals, ostracods, bryozoans, echinoids, mollusks, fishes, and marine mammals. This record adheres to the FAIR principles, is updated in terms of taxonomy, and follows the currently accepted stratigraphic framework. Based on this record, knowledge gaps are identified, which are due to spatiotemporal inconsistencies in sampling effort and the distribution of sedimentary facies, as well as the inherent differences in the preservation potential between the groups. Additionally, sampling bias in old records may have distorted the record in favor of larger, more impressive taxa within groups. This record is now ready to be used to answer both geological and biological questions about the Mediterranean Sea and beyond and is amendable when new fossil data are brought to light.

Abstract There is need for advancing minimally invasive diagnostic techniques for sex differentiation at early life-stage classes in sea turtles. The objectives of this study were to determine whether there are sex-specific effects on the metabolome of the loggerhead sea turtle (Caretta caretta) and to identify potential biomarkers for sex classification at early life-stage classes (50 post-hatchling and 50 juvenile). Comprehensive analyses including plasma chemistry (n = 100) and untargeted (n = 48) metabolomic analyses were performed. Unlike with plasma chemistry analytes, there were significant differences in the metabolomic profiles between sexes. Nine metabolites differed significantly between sexes, with several metabolites deserving greater attention as potential biomarkers: C22H32O6 and pantothenic acid was higher in females than in males, and carboxylic acid ester (C10H16O5), 1-methylhistidine and C7H14N2O7 was higher in males than females. These differences remained constant both across and within the same life-stage class. This work identified a discernible effect on the metabolic profile based on sex of loggerhead sea turtles and it suggests that these metabolites and/or their ratios could serve as potential biomarker candidates for sex classification in this species.

The new trend in urban stormwater management is to preserve natural hydrological conditions by addressing changes from urbanization. The software Chaak: Urban Hydrological Impact Modeling is a new hydroinformatics tool designed for sustainable modeling, simulation, and analysis of stormwater sewer networks. It emphasizes two key aspects: enhancing planning for Sustainable Urban Drainage Systems (SUDS) to restore natural hydrological conditions and providing an alternative to conventional storm drainage designs. Additionally, it encourages global scientific collaboration to quickly advance the tool's capabilities through structured development and quality control.

Abstract Upper mantle deformation is mainly controlled by the mechanical behavior of olivine. Crystallographic preferred orientations (CPOs) develop in olivine due to crystal‐plastic deformation during mantle flow, where the a‐axes of olivine polycrystalline aggregates are aligned with the flow direction. Therefore, the observed CPO in olivine‐rich rocks is used as an indicator of the mantle flow direction. Experimental data show that olivine rheology is strongly controlled by the microstructure. While the influence of plastic deformation is in general well characterized, the role of dynamic recrystallization during deformation is not totally understood, limiting our ability to interpret the deformation history of naturally deformed rocks. This contribution presents microdynamic numerical simulations of olivine polycrystalline aggregates with different iron content (i.e., fayalite content) with the aim of exploring the CPO and grain size response to dynamic recrystallization. We use a full‐field approach with an explicit simulation of viscoplastic deformation and dynamic recrystallization processes under simple shear boundary conditions up to high strain. The simulations show that the CPOs are similar and practically reach the same maximum regardless of the iron content. CPOs are characterized by a single cluster of a‐axis and two‐clusters of b‐axis, reveling a joint activity of the easy glide [100](010) and the moderate strength [100](010) slip systems. High‐strain domains of our models are consistent with experimental results, showing an A‐type fabric with double maxima, and where the CPO is aligned with the shear direction. The model provides a deeper understanding of the dynamic recrystallization influence on olivine CPOs resulting from plastic deformation.

Introduction and aim: Endoscopic retrograde cholangiopancreatography (ERCP) is a complex procedure. Clinical guidelines assess competence in ERCP through a defined number of procedures, but multiple factors are involved. Our aim was to analyze the morphology of the papilla of Vater as an independent factor in selective common bile duct cannulation during resident training. Material and methods: Patients that underwent ERCP were studied consecutively. All ERCPs were begun by a resident in training. The type of papilla was classified according to Haraldsson, including those with previous sphincterotomy. Cannulation difficulty and success and their relation to the type of papilla were documented. The analysis was divided into three 4-month periods. Results: Of the 429 patients, cannulation was difficult in 101 (23.5%). The residents achieved selective cannulation of the common bile duct in 276 (64.3%) and the cannulation success rate at the end of their training was 81.7%. Cannulation was performed with the least difficulty in papillae with previous sphincterotomy (2.8%), unlike the type 4 papilla, which was difficult to cannulate in 50% of the cases. The lowest overall cannulation success was in the type 2 papilla (81.8%). Conclusion: Papilla type can influence cannulation success, but it is not the only related factor. Patients that underwent previous sphincterotomy appear to be the cases in whom ERCP training can be started. Resumen: Introducción: La colangiografía retrograda endoscópica (CPRE) es un procedimiento complejo. Las guías clínicas evalúan la competencia en CPRE mediante un número definido de procedimientos, sin embargo, existen múltiples factores que influyen en ello. El objetivo fue analizar la morfología de la papila de Vater como factor independiente en la canulación selectiva del colédoco durante el entrenamiento del residente. Material y métodos: Se estudiaron pacientes sometidos a CPRE de manera consecutiva. Todas las CPRE fueron iniciadas por el residente. Se clasificó el tipo de papila según Haraldsson, incluyendo a las papilas con esfinterotomía previa. La dificultad, el éxito en la canulación y su relación con el tipo de papila fueron documentados. El análisis se dividió en tres períodos de cuatro meses. Resultados: De los 429 pacientes se determinó canulación difícil en 101 (23.5%). Los residentes lograron una canulación selectiva del colédoco en 276 (64.3%) y su éxito de canulación al final de su entrenamiento fue del 81.7%. La papila con esfinterotomía previa representó la menor dificultad en la canulación (2.8%), a diferencia de la papila tipo 4 que fue de canulación difícil en 50% de los casos. La papila tipo 2 presentó el menor éxito global de canulación (81.8%). Conclusión: El tipo de papila puede influir en el éxito de canulación, sin embargo, no es el único factor relacionado al éxito del mismo. Los pacientes con esfinterotomía previa parecen ser los indicados para iniciar el entrenamiento en CPRE.

Abstract Hand stencils are a remarkable graphic expression in Prehistoric rock art, dating back to 42 ka BP. Although these stencils provide direct impressions of the artists’ hands, the characterization of their biological profile (i.e., biological sex and age) is very challenging. Previous studies have attempted this analysis with traditional morphometrics (TM), whereas little research has been undertaken using Geometric Morphometrics (GM), a method widely used in other disciplines but only tentatively employed in rock art studies. However, the large variation in relative finger position in archaeological hands poses the question of whether these representations can be examined through GM, or, in contrast, if this creates an unmanageable error in the results. To address this issue, a 2D hand scans sample of 70 living individuals (F = 35; M = 35) has been collected in three standardized positions (n = 210) and digitized with 32 2D conventional landmarks. Results show that the intra-individual distance (mean Procrustes distance between Pos. 1–2 = 0.132; 2–3 = 0.191; 1–3 = 0.292) is larger than the inter-individual distance (mean in 1 = 0.122; 2 = 0.142; 3 = 0.165). Finally, it has been demonstrated that the relative finger positions, as well as the inclusion of all hand parts in the analysis, have an overshadowing effect on other variables potentially involved in the morphometric variability of the hand, such as biological sex.

Abstract Background The term sepsis refers to a complex and heterogeneous syndrome. Although great progress has been made in improving the diagnosis and treatment of this condition, it continues to have a huge impact on morbidity and mortality worldwide. Mesenchymal stem cells are a population of multipotent cells that have immunomodulatory properties, anti-apoptotic effects, and antimicrobial activity. We studied these capacities in a porcine model of peritoneal sepsis. Methods We infused human adipose-derived mesenchymal stem cells (ADSCs) into a porcine model of peritoneal sepsis. Twenty piglets were treated with antibiotics alone (control group) or antibiotics plus peritoneal infusion of ADSCs at a concentration of 2 × 106 cells/kg or 4 × 106 cells/kg (low- and high-dose experimental groups, respectively). The animals were evaluated at different time points to determine their clinical status, biochemical and hematologic parameters, presence of inflammatory cytokines and chemokines in blood and peritoneal fluid, and finally by histologic analysis of the organs of the peritoneal cavity. Results One day after sepsis induction, all animals presented peritonitis with bacterial infection as well as elevated C-reactive protein, haptoglobin, IL-1Ra, IL-6, and IL-1b. Xenogeneic ADSC infusion did not elicit an immune response, and peritoneal administration of the treatment was safe and feasible. One day after infusion, the two experimental groups showed a superior physical condition (e.g., mobility, feeding) and a significant increase of IL-10 and TGF-β in blood and a decrease of IL-1Ra, IL-1b, and IL-6. After 7 days, all animals treated with ADSCs had better results concerning blood biomarkers, and histopathological analysis revealed a lower degree of inflammatory cell infiltration of the organs of the peritoneal cavity. Conclusions Intraperitoneal administration of ADSCs as an adjuvant therapy for sepsis improves the outcome and diminishes the effects of peritonitis and associated organ damage by regulating the immune system and reducing intra-abdominal adhesions in a clinically relevant porcine model of abdominal sepsis.

Introduction Women experiencing severe perinatal mental health problems require specialized services and care. Perinatal mental disorders are common and can contribute to maternal mortality, affecting neonatal, infant, and child outcomes. Home treatment can prevent hospital admissions and promote strategies within the patient’s support network. Objectives Our aim is to describe a clinical case in perinatal psychiatry managed by a Psychiatric Home Treatment Unit. Methods We present a case of perinatal psychotic depression in a 26-year-old pregnant woman. Results We describe the case of a patient with no prior history of mental health issues. She was 25 weeks pregnant when she first sought psychiatric help in July 2023 and was diagnosed with depressive disorder with psychotic symptoms. She reported symptoms such as low mood, psychomotor inhibition, delusional guilt thoughts, and auditory hallucinations beginning three weeks before her initial visit. Due to her clinical presentation, the patient was admitted to the hospital, where pharmacological treatment was initiated with Olanzapine 5 mg, Sertraline 50 mg, and Lorazepam 1.5 mg. She remained in the hospital for four days, during which she showed gradual improvement but did not achieve full recovery. Considering the improvement observed, home treatment was proposed and accepted by the patient and her relatives. During home treatment, she continued to exhibit persistent depressive and psychotic symptoms, including low mood, inhibition, and delusional thoughts of ruin and catastrophe. Therefore, her treatment was adjusted, with Olanzapine increased to 10 mg, Sertraline raised to 100 mg, and Lorazepam reduced to 0.75 mg. Over time, significant improvement in her clinical symptoms was noted. Throughout the follow-up period, she reported no significant side effects from the pharmacological treatment. After a month of follow-up in our department, she was discharged with outpatient care provided by a specialized community perinatal psychiatric unit. Conclusions We illustrate the possibility of home treatment for perinatal psychiatric disorders. The potential benefits of remaining close to one’s support network and developing coping strategies can be advantageous during the course of illness. Further studies should be conducted to explore these potential benefits. Disclosure of Interest None Declared

Introduction: The COVID-19 pandemic has caused an unexpected boost to telemedicine. We analyse the impact of the pandemic on telemedicine applied in Spanish headache consultations, review the literature, and issue recommendations for the implementation of telemedicine in consultations. Method: The study comprised 3 phases: 1) review of the MEDLINE database since 1958 (first reported experience with telemedicine); 2) Google Forms survey sent to all members of the Spanish Society of Neurology’s Headache Study Group (GECSEN); and 3) online consensus of GECSEN experts to issue recommendations for the implementation of telemedicine in Spain. Results: COVID-19 has increased waiting times for face-to-face consultations, increasing the use of all telemedicine modalities: landline telephone (from 75% before April 2020 to 97% after), mobile telephone (from 9% to 27%), e-mail (from 30% to 36%), and video consultation (from 3% to 21%). Neurologists are aware of the need to expand the availability of video consultations, which are clearly growing, and other e-health and m-health tools. Conclusions: The GECSEN recommends and encourages all neurologists who assist patients with headaches to implement telemedicine resources, with the optimal objective of offering video consultation to patients under 60-65 years of age and telephone calls to older patients, although each case must be considered on an individual basis. Prior approval and advice must be sought from legal and IT services and the centre’s management. Most patients with stable headache and/or neuralgia are eligible for telemedicine follow-up, after a first consultation that must always be held in person. Resumen: Introducción: La pandemia COVID-19 ha provocado un inusitado impulso a la Telemedicina (TM). Analizamos el impacto de la pandemia en la TM aplicada en las consultas de cefaleas españolas, revisamos la literatura y lanzamos unas recomendaciones para implantar la TM en las consultas. Método: Tres fases: 1) Revisión de la base Medline desde el año 1958 (primera experienciade TM); 2) Formulario Google Forms enviado a todos los neurólogos del Grupo de Estudio de Cefaleas de la Sociedad Espa˜nola de Neurología (GECSEN), y 3) Consenso on-line de expertos GECSEN para emitir recomendaciones para implantar la TM en. España. Resultados: La pandemia por COVID-19 ha empeorado los tiempos de espera presenciales, incrementando el uso de todas las modalidades de TM antes y después de abril de 2020: teléfono fijo (del 75% al 97%), teléfono móvil (del 9% al 27%), correo electrónico (del 30% al 36%), y videoconsulta (del 3% al 21%). Los neurólogos son conscientes de la necesidad de ampliar la oferta con videoconsultas, claramente in crescendo, y otras herramientas de e-health y m-health. Conclusiones: Desde el GECSEN recomendamos y animamos a todos los neurólogos que asisten a pacientes con cefaleas a implantar recursos de TM, teniendo como objetivo óptimo la videoconsulta en menores de 60-65 años y la llamada telefónica en mayores, si bien cada caso debe individualizarse. Se deberá contar previamente con la aprobación y asesoramiento de los servicios jurídicos e informáticos y de la dirección del centro. La mayoría de los pacientes con cefalea y/o neuralgia estable son candidatos a seguimiento mediante TM, tras una primera visita que tiene que ser siempre presencial.

Resumen: Introducción: La pandemia COVID-19 ha provocado un inusitado impulso a la telemedicina (TM). Analizamos el impacto de la pandemia en la TM aplicada en las consultas de cefaleas españolas, revisamos la literatura y lanzamos unas recomendaciones para implantar la TM en las consultas. Método: Tres fases: 1) Revisión de la base Medline desde el año 1958 (primera experiencia de TM); 2) Formulario Google Forms enviado a todos los neurólogos del Grupo de Estudio de Cefaleas de la Sociedad Española de Neurología (GECSEN), y 3) Consenso on-line de expertos GECSEN para emitir recomendaciones para implantar la TM en España. Resultados: La pandemia por COVID-19 ha empeorado los tiempos de espera presenciales, incrementando el uso de todas las modalidades de TM antes y después de abril de 2020: teléfono fijo (del 75% al 97%), teléfono móvil (del 9% al 27%), correo electrónico (del 30% al 36%) y videoconsulta (del 3% al 21%). Los neurólogos son conscientes de la necesidad de ampliar la oferta con videoconsultas, claramente in crescendo, y otras herramientas de e-health y m-health. Conclusiones: Desde el GECSEN recomendamos y animamos a todos los neurólogos que asisten a pacientes con cefaleas a implantar recursos de TM, teniendo como objetivo óptimo la videoconsulta en menores de 60-65 años y la llamada telefónica en mayores, si bien cada caso debe individualizarse. Se deberá contar previamente con la aprobación y asesoramiento de los servicios jurídicos e informáticos y de la dirección del centro. La mayoría de los pacientes con cefalea y/o neuralgia estable son candidatos a seguimiento mediante TM, tras una primera visita que tiene que ser siempre presencial. Abstract: Introduction: The COVID-19 pandemic has caused an unexpected boost to telemedicine. We analyse the impact of the pandemic on telemedicine applied in Spanish headache consultations, review the literature, and issue recommendations for the implementation of telemedicine in consultations. Method: The study comprised 3 phases: 1) review of the MEDLINE database since 1958 (first reported experience with telemedicine); 2) Google Forms survey sent to all members of the Spanish Society of Neurology's Headache Study Group (GECSEN); and 3) online consensus of GECSEN experts to issue recommendations for the implementation of telemedicine in Spain. Results: COVID-19 has increased waiting times for face-to-face consultations, increasing the use of all telemedicine modalities: landline telephone (from 75% before April 2020 to 97% after), mobile telephone (from 9% to 27%), e-mail (from 30% to 36%), and video consultation (from 3% to 21%). Neurologists are aware of the need to expand the availability of video consultations, which are clearly growing, and other e-health and m-health tools. Conclusions: The GECSEN recommends and encourages all neurologists who assist patients with headaches to implement telemedicine resources, with the optimal objective of offering video consultation to patients under 60-65 years of age and telephone calls to older patients, although each case must be considered on an individual basis. Prior approval and advice must be sought from legal and IT services and the centre's management. Most patients with stable headache and/or neuralgia are eligible for telemedicine follow-up, after a first consultation that must always be held in person.

Abstract Purpose This study aims to assess the impact of a peer intervention programme in the hospital setting to improve the health-related quality of life (HRQoL) of people recently diagnosed with HIV infection. Methods A quasi-experimental single-group study with pre- and post-measurements was conducted. The peer intervention programme consisted of four sessions that took place at the following times: (1) the day of diagnosis, (2) the day when the results of the analyses were collected and ART (antiretroviral therapy) began, (3) one month after the start of ART, and (4) four months after the start of ART. The dependent variables were HRQoL and several of its psychological predictors. Change in the dependent variables was analysed through repeated measures, variance analysis and covariance analysis. Forty-three people with HIV participated in the intervention (40 men, mean age = 39.14). Results A significant positive evolution was found in all the predictors of HRQoL, except avoidant coping (p

Introduction: Headache is a frequent cause of consultation; it is important to detect patients with secondary headache, particularly high-risk secondary headache. Such systems as the Manchester Triage System (MTS) are used for this purpose. This study aims to evaluate the frequency of undertriage in patients attending the emergency department due to headache. Material and methods: We studied a series of consecutive patients who came to the emergency department with headache and presenting some warning sign, defined as the presence of signs leading the physician to request an emergency neuroimaging study and/or assessment by the on-call neurologist. The reference diagnosis was established by neurologists. We evaluated the MTS triage level assigned and the presence of warning signs that may imply a higher level than that assigned. Results: We registered a total of 1120 emergency department visits due to headache, and 248 patients (22.8%) were eligible for study inclusion. Secondary headache was diagnosed in 126 cases (50.8% of the sample; 11.2% of the total), with 60 cases presenting high-risk secondary headache (24.2%; 5.4%). According to the MTS, 2 patients were classified as immediate (0.8%), 26 as very urgent (10.5%), 147 as urgent (59.3%), 68 as normal (27.4%), and 5 as not urgent (2%). The percentage of patients undertriaged was 85.1% in the very urgent classification level and 23.3% in the urgent level. Conclusion: During the study period, at least one in 10 patients attending the emergency department due to headache had secondary headache; one in 20 had high-risk secondary headache. The MTS undertriaged most patients with warning signs suggesting a potential emergency. Resumen: Introducción: La cefalea es un motivo de consulta urgente frecuente, siendo la prioridad detectar a pacientes con cefalea secundaria, especialmente cefaleas secundarias de alto riesgo (CESAR). Para ello, se emplean sistemas de triaje como el Sistema de Triaje de Manchester (STM). Pretendemos evaluar la frecuencia de subtriaje en pacientes que acudieron a urgencias por cefalea. Material y métodos: Estudio de serie de casos consecutivos. Se analizaron pacientes que acudieron a urgencias refiriendo cefalea y tuvieron algún dato de alarma, definido como la presencia de datos que motivasen la solicitud de neuroimagen urgente y/o la valoración por neurología de guardia. El diagnóstico de referencia fue realizado por neurólogos. Se evaluó el nivel de triaje asignado por el STM y la presencia de datos de alarma que implicaría el triaje en un nivel superior al asignado. Resultados: Hubo 1120 visitas a urgencias por cefalea, siendo elegibles 248 pacientes (22,8%). Se diagnosticó cefalea secundaria en 126 casos (50,8% de la muestra, 11,2% del total), siendo 60 CESAR (24,2% y 5,4%). El STM clasificó 2 pacientes como críticos (0,8%), 26 emergencias (10,5%), 147 urgencias (59,3%), 68 como estándar (27,4%) y 5 como no urgente (2%).El porcentaje de pacientes infratriados fue del 85,1% en el nivel “emergencia” y 23,3% en el de “urgencia”. Conclusión: Durante el periodo de estudio, al menos uno de cada diez pacientes que acudió a urgencias por cefalea tenía una cefalea secundaria y uno de cada veinte una CESAR. El STM infratrió a la mayoría de pacientes con datos que implicarían una potencial emergencia.

Stressful events appear to be risky situations that can precipitate the consumption of drugs. One way to recreate stressful contexts, in an ecological and controlled method, is through immersive virtual reality (VR). In our study, we designed the scenario of an elevated plus-maze (EPM) using VR, which is widely used in animal models to assess unconditioned anxiety. This task allowed us to analyze the behavioral, psychophysiological (heart rate and electrodermal activity), and hormonal response (salivary cortisol and Alpha-amylase) to this stressful situation in different moments (before VR task (anticipation), at the end of the task and 10 minutes later) in young people with problematic alcohol use (AU, n = 27), alcohol combined with cannabis consumption (AU + C, n = 10), as well as in a control group (CO, n = 33). Behavioral analysis revealed that the AU group displayed fewer entries into open arms than the CO group, whereas both experimental groups spent less time at the end of the open arms, as well as lower time by look down index compared to the CO group. Moreover, our VR EPM induced different psychophysiological responses in the different moments measured. In general, electrodermal activity seemed to be a good biomarker of recovery from a stressful situation, as once the exposure to the stressful situation ended, the AU + C group took longer to recover compared to the CO group. Regarding hormonal analyses, we observed a similar response pattern in all groups suggesting that our VR task was able to activate both stress systems. The alpha-amylase to cortisol ratio, proposed as a biomarker of stress systems dysregulation, was higher in the group of young participants with alcohol abuse. Interestingly, our VR EPM was able to induce a slight alcohol craving in both experimental groups. In conclusion, our results suggest certain subtle behavioral and physiological differences that could be used to detect young individuals at risk of future severe addictions or other stress-related comorbidities. Moreover, it could help us to develop prevention strategies focused on emotional, cognitive, and psychophysiological aspects.

Abstract Background Treating complex perianal fistulas in Crohn’s disease patients remains a challenge. Classical surgical treatments for Crohn’s disease fistulas have been extrapolated from cryptoglandular fistulas treatment, which have different etiology, and this might interfere with its effectiveness, in addition, they increase fecal incontinence risk. Recently, new surgical techniques with support from biological approaches, like stem cells, have been developed to preserve the function of the sphincter. We have performed a systematic literature review to compare the results of these different techniques in the treatment of Crohn’s or Cryptoglandular fistula. Methods PubMed, EMBASE, Database of Abstracts of Reviews of Effectiveness, Cochrane Central Register of Controlled Trials were searched systematically for relevant articles. We included randomized controlled trials and observational studies that referred to humans, were written in English, included adults 18+ years old, and were published during the 10-year period from 2/01/2010 to 2/29/2020. Evidence level was assigned as designated by the Scottish Intercollegiate Guidelines Network. Results Of the 577 citations screened, a total of 79 were ultimately included in our review. In Crohn’s disease patients, classical techniques such as primarily seton, Ligation of Intersphincteric Fistula Tracks, or lay open, healing rates were approximately 50–60%, while in cryptoglandular fistula were around, 70–80% for setons or flaps. In Crohn’s disease patients, new surgical techniques using derivatives of adipose tissue reported healing rates exceeding 70%, stem cells-treated patients achieved higher combined remission versus controls (56.3% vs 38.6%, p = 0.010), mesenchymal cells reported a healing rate of 80% at week 12. In patients with cryptoglandular fistulas, a healing rate of 70% using derivatives of adipose tissue or platelets was achieved, and a healing rate of 80% was achieved using laser technology. Fecal incontinence was improved after the use of autologous platelet growth factors and Nitinol Clips. Conclusion New surgical techniques showed better healing rates in Crohn’s disease patients than classical techniques, which have better results in cryptoglandular fistula than in Crohn’s disease. Healing rates for complex cryptoglandular fistulas were similar between the classic and new techniques, being the new techniques less invasive; the incontinence rate improved with the current techniques.

Parasites extracted from the lungs and the pterygoid sinus complex of 6 species of odontocetes stranded along the north-west Spanish coast (Northeast Atlantic) between 2009 and 2019 were morphologically identified. The samples belonged to 14 specimens, including 3 harbour porpoises, Phocoena phocoena, 6 short-finned pilot whales, Globicephala macrorhynchus, 1 long-finned pilot whale, Globicephala melas, 1 Risso's dolphin, Grampus griseus, 1 striped dolphin, Stenella coeruleoalba and 2 bottlenose dolphins, Tursiops truncatus. All animals (14/14) were infected by nematodes of the genus Stenurus spp.; moreover, two of them presented a mixed lung nematode infection by Stenurus spp. and Halocercus spp., and another two a mixed infection by Stenurus spp. and the trematode Nasitrema spp. in the pterygoid sinuses. The morphological characterization of the Stenurus specimens revealed the existence of three different species: Stenurus minor, present in the pterygoid sinuses of harbour porpoises with a mean intensity of 43.0 ± 9.0; Stenurus globicephalae, in the pterygoid sinuses of pilot whales and the Risso's dolphin (370.3 ± 579.4); and Stenurus ovatus infecting bottlenose and striped dolphins’ lungs (47.7 ± 76.5). This is the first citation of S. minor and S. ovatus in odontoceti from the Galician coast. Nematodes of the genus Stenurus are frequent in odontocetes stranded along the north-west Spanish coast. A clear host-parasite association was observed between S. minor and the Phocoenidae family, between S. globicephalae and the subfamily Globicephalinae and between S. ovatus and subfamily Delphininae. Different trophic position and niche segregation may lead to different patterns of specificity.

Introduction: Fifty percent of small bowel bleeding is caused by angioectasia and the rebleeding rate due to small bowel angioectasia (SBA) is 80%. Its endoscopic treatment is difficult. Beneficial effects of octreotide on gastrointestinal angioectasia have been described, but no studies have reported its efficacy in SBA. Aim: Our aim was to investigate the effectiveness of octreotide in the prevention of rebleeding due to SBA. Material and methods: Sixteen patients with bleeding caused by SBA were assigned to treatment with octreotide 100 μg/24 h SC, for at least 6 months, and compared with a non-treatment group of 36 patients. The primary outcome was the rebleeding rate, and the secondary outcomes were the number of hospital readmissions, bleeding-related death, and adverse effects. Results: Octreotide was administered for 10.5 ± 8.4 months. Follow-up was 12.9 ± 17.3 months and 15.3 ± 17.7 months, in the treatment and non-treatment groups, respectively (p = 0.09). At the end of follow-up, 4 (25%) treatment group patients and 26 (72.2%) non-treatment group patients presented with rebleeding (p = 0.002). In the treatment group and non-treatment group, the cumulative probability of remaining rebleeding-free at one year was 79% vs 44.2%, and 79% vs 34.6% at 2 years, respectively (p = 0.05). Through the multiple logistic regression analysis, treatment was the protective variable. Six patients presented with adverse events. One of those patients (6.25%) had a major adverse event. Conclusions: Our results suggest that treatment with octreotide could be efficacious in the prevention of rebleeding due to SBA. Resumen: Introducción: El 50% de las hemorragias del intestino delgado son causadas por angiectasias del intestino delgado (AID) y la tasa de recurrencia es del 80%. Su tratamiento endoscópico es difícil. Algunos estudios han informado efectos beneficiosos del octreótido en angiectasias del tubo digestivo, pero ninguno ha evaluado su eficacia en las AID. Objetivo: Investigar la efectividad del octreótido en la prevención de la recurrencia hemorrágica de las AID. Material y métodos: Dieciséis pacientes con sangrado por AID fueron asignados a un tratamiento con octreótido 100 μg/24 h SC por al menos 6 meses. Esta cohorte se comparó con un grupo de 36 pacientes no tratados. El desenlace primario fue la tasa de recurrencia hemorrágica y los secundarios fueron el número de reingresos hospitalarios, muerte relacionada con el sangrado, y efectos adversos. Resultados: Se administró octreótido durante 10.5 ± 8.4 meses. El seguimiento fue de 12.9 ± 17.3 y 15.3 ± 17.7 meses en pacientes tratados y no tratados (p = 0.09). Al final del seguimiento, el sangrado recurrente se produjo en 4 (25%) pacientes del grupo tratado y en 26 (72.2%) del grupo no tratado (p = 0.002). La probabilidad acumulada de permanecer libre de hemorragia recurrente al año fue del 79% vs. 44.2% y a los 2 años, del 79% vs. 34.6% en el grupo tratado y no tratado, respectivamente (p = 0.05). De acuerdo con el análisis de regresión logística múltiple, el tratamiento fue variable protectora. Los eventos adversos ocurrieron en 6 pacientes. En uno de ellos fueron eventos mayores (6.25%). Conclusiones: Estos resultados sugieren que el tratamiento con octreótido podría ser eficaz para prevenir las hemorragias recurrentes por AID.

Resumen: Introducción: El 50% de las hemorragias del intestino delgado son causadas por angiectasias del intestino delgado (AID) y la tasa de recurrencia es del 80%. Su tratamiento endoscópico es difícil. Algunos estudios han informado efectos beneficiosos del octreótido en angiectasias del tubo digestivo, pero ninguno ha evaluado su eficacia en las AID. Objetivo: Investigar la efectividad del octreótido en la prevención de la recurrencia hemorrágica de las AID. Material y métodos: Dieciséis pacientes con sangrado por AID fueron asignados a un tratamiento con octreótido 100 μg/24 h SC por al menos 6 meses. Esta cohorte se comparó con un grupo de 36 pacientes no tratados. El desenlace primario fue la tasa de recurrencia hemorrágica y los secundarios fueron el número de reingresos hospitalarios, muerte relacionada con el sangrado, y efectos adversos. Resultados: Se administró octreótido durante 10.5 ± 8.4 meses. El seguimiento fue de 12.9 ± 17.3 y 15.3 ± 17.7 meses en pacientes tratados y no tratados (p = 0.09). Al final del seguimiento, el sangrado recurrente se produjo en 4 (25%) pacientes del grupo tratado y en 26 (72.2%) del grupo no tratado (p = 0.002). La probabilidad acumulada de permanecer libre de hemorragia recurrente al año fue del 79% vs. 44.2% y a los 2 años, del 79% vs. 34.6% en el grupo tratado y no tratado, respectivamente (p = 0.05). De acuerdo con el análisis de regresión logística múltiple, el tratamiento fue variable protectora. Los eventos adversos ocurrieron en 6 pacientes. En uno de ellos fueron eventos mayores (6.25%). Conclusiones: Estos resultados sugieren que el tratamiento con octreótido podría ser eficaz para prevenir las hemorragias recurrentes por AID. Abstract: Introduction: Fifty percent of small bowel bleeding is caused by angioectasia and the rebleeding rate due to small bowel angioectasia (SBA) is 80%. Its endoscopic treatment is difficult. Beneficial effects of octreotide on gastrointestinal angioectasia have been described, but no studies have reported its efficacy in SBA. Aim: Our aim was to investigate the effectiveness of octreotide in the prevention of rebleeding due to SBA. Material and methods: Sixteen patients with bleeding caused by SBA were assigned to treatment with octreotide 100 μg/24 h SC, for at least 6 months, and compared with a non-treatment group of 36 patients. The primary outcome was the rebleeding rate, and the secondary outcomes were the number of hospital readmissions, bleeding-related death, and adverse effects. Results: Octreotide was administered for 10.5 ± 8.4 months. Follow-up was 12.9 ± 17.3 months and 15.3 ± 17.7 months, in the treatment and non-treatment groups, respectively (p = 0.09). At the end of follow-up, 4 (25%) treatment group patients and 26 (72.2%) non-treatment group patients presented with rebleeding (p = 0.002). In the treatment group and non-treatment group, the cumulative probability of remaining rebleeding-free at one year was 79% vs 44.2%, and 79% vs 34.6% at 2 years, respectively (p = 0.05). Through the multiple logistic regression analysis, treatment was the protective variable. Six patients presented with adverse events. One of those patients (6.25%) had a major adverse event. Conclusions: Our results suggest that treatment with octreotide could be efficacious in the prevention of rebleeding due to SBA.

Introduction: Headache is the most common neurological complaint at the different levels of the healthcare system, and clinical history and physical examination are essential in the diagnosis and treatment of these patients. With the objective of unifying the care given to patients with headache, the Spanish Society of Neurology’s Headache Study Group (GECSEN) has decided to establish a series of consensus recommendations to improve and guarantee adequate care in primary care, emergency services, and neurology departments. Methods: With the aim of creating a practical document, the recommendations follow the dynamics of a medical consultation: clinical history, physical examination, and scales quantifying headache impact and disability. In addition, we provide recommendations for follow-up and managing patients’ expectations of the treatment. Conclusions: With this tool, we aim to improve the care given to patients with headache in order to guarantee adequate, homogeneous care across Spain. Resumen: Introducción: La cefalea es el motivo de consulta neurológico más prevalente en los distintos niveles asistenciales, donde la anamnesis y exploración son primordiales para realizar un diagnóstico y tratamiento adecuados. Con la intención de unificar la atención de esta patología, el Grupo de Estudio de Cefalea de la Sociedad Española de Neurología (GECSEN) ha decidido elaborar unas recomendaciones consensuadas para mejorar y garantizar una adecuada asistencia en Atención Primaria, Urgencias y Neurología. Metodología: El documento es práctico, sigue el orden de la dinámica de actuación durante una consulta: anamnesis, escalas que cuantifican el impacto y la discapacidad y exploración. Además, finaliza con pautas para realizar un seguimiento adecuado y un manejo de las expectativas del paciente con el tratamiento pautado. Conclusiones: Esperamos ofrecer una herramienta que mejore la atención al paciente con cefalea para garantizar una asistencia adecuada y homogénea a nivel nacional.

Introduction Different studies indicate high prevalence’s of suicidal behaviour, anxiety, depression, insomnia, and PTSD associated with the COVID-19 pandemic. There is currently not enough scientific evidence available to analyze the impact that the COVID-19 pandemic has had on the rate of suicide attempts and their characteristics. Objectives To analyze and compare the characteristics of suicidal behavior (in terms of method, severity, medical damage produced and need for hospitalization) of patients attended during the COVID-19 pandemic compared to previous years. Methods A retrospective study was performed based on a standardized data collection of patients attending the University Hospital La Paz between April 2018 and November 2021. 581 patients who attempted suicide at least once were included in this study. We compared the severity using the Beck Suicide Intent Scale. Chi-square ant Student’s t were used to compare clinical characteristics such as medical damage, method of suicide attempt and indication for admission after the attempt, between suicide attempts during the COVID-19 pandemic and previous years. Results Our results suggest that during the COVID-19 pandemic suicide attempts caused more medical damage (p

Creep due to ice flow is generally thought to be the main cause for the formation of crystallographic preferred orientations (CPOs) in polycrystalline anisotropic ice. However, linking the development of CPOs to the ice flow history requires a proper understanding of the ice aggregate's microstructural response to flow transitions. In this contribution the influence of ice deformation history on the CPO development is investigated by means of full-field numerical simulations at the microscale. We simulate the CPO evolution of polycrystalline ice under combinations of two consecutive deformation events up to high strain, using the code VPFFT (visco-plastic fast Fourier transform algorithm) within ELLE. A volume of ice is first deformed under coaxial boundary conditions, which results in a CPO. The sample is then subjected to different boundary conditions (coaxial or non-coaxial) in order to observe how the deformation regime switch impacts the CPO. The model results indicate that the second flow event tends to destroy the first, inherited fabric with a range of transitional fabrics. However, the transition is slow when crystallographic axes are critically oriented with respect to the second imposed regime. Therefore, interpretations of past deformation events from observed CPOs must be carried out with caution, particularly in areas with complex deformation histories.

The European Ground Motion Service provides a plethora of information about land subsidence in the form of Persistent Scatterers (PS). Data for all over Europe will be soon available, facilitating the analysis of ground deformation at a continental level. However, Active Deformation Areas (ADA) may be used instead of PS, since those are more understandable for humans. The CTTC already developed a tool, namely ADAfinder, to produce the said ADAs out of input PS. The authors are involved in an ongoing project, at its very early stages, targeted at computing the Active Deformation Areas for all Europe using the PS data provided by the EGMS, making the results available to the community by means of a WebGIS. A few concepts are already very clear, such as the high volume of information to process, the need of a specific software chain to do the actual processing and the economic cost that storing and making the results accessible might imply. This paper describes how the data volume and economic factors led to the selection of an in-house hosted & developed solution rather than resorting to well-established and expensive providers of cloud-based solutions. Furthermore, the set of self-developed tools required to implement the production chain are also explained. Also, the open-source tool used to prepare a server able to store the data and make it available to the public are described here. Very preliminary but promising figures concerning processing and response times have been included too.

Abstract Background This study aimed to measure the toxicity resulting from collagenase administration to the peritoneal cavity in a pig model as a preliminary step to break down the stroma surrounding tumors. Methods Eight pigs were treated with 2 different collagenase concentrations previously tested in rats by our group. Time and temperature were controlled using a peritoneal lavage system (PRS System, Combat Medical Ltd.) identical to that used in human surgeries through hyperthermic intraperitoneal chemotherapy (HIPEC); 2 additional pigs were treated with peritoneal lavage only. Samples of blood and peritoneal fluid were collected pre-treatment, immediately after treatment, and 24 h postoperatively. In addition, histological studies and blood collagenase levels were measured. Results No complications were observed during the surgeries. Intraoperative images evidenced the release of peritoneal tissue during collagenase treatment. After surgery, the animals showed no signs of pain. Diet and mobility were normal at 4 h postoperatively, and there were no significant differences in hematologic or biochemical parameters. Quantification of MMP1 and MMP2 in all samples as measured by absorbance showed no differences in blood collagenase levels between pre-treatment, post-treatment, and 24 h postoperatively. None of the animals treated with collagenase showed peritoneal adhesions during the second surgery. Histologically, peritoneal organs and serous structures did not show any microscopic alterations associated with collagenase treatment in any group. Conclusion Lavage of the peritoneal cavity with doses of up to 100,000 collagen digestion units/animal for 30 min is safe and removes connective tissue from the peritoneal cavity.

Abstract Background Obesity is caused by the enlargement of the white adipose tissue (WAT) depots, characterized by the hypertrophic enlargement of malfunctioning adipocytes within WAT which increases the storage of triglycerides (TG) in the lipid droplets (LD). Adipogenesis pathways as well as the expression and activity of some extracellular matrix receptors integrins are upregulated. Integrinβ1 (INTB1) is the main isoform involved in WAT remodeling during obesity and insulin resistance-related diseases. We recently described Integrin Linked Kinase (ILK), a scaffold protein recruited by INTB1, as an important mediator of WAT remodeling and insulin resistance. As the few approved drugs to fight obesity have brought long-term cardiovascular side effects and given that the consideration of INTB1 and/or ILK modulation as anti-obesogenic strategies remains unexplored, we aimed to evaluate the anti-obesogenic capacity of the clinically approved anticoagulant Tirofiban (TF), stated in preclinical studies as a cardiovascular protector. Methods Fully differentiated adipocytes originating from C3H10T1/2 were exposed to TF and were co-treated with specific INTB1 blockers or with siRNA-based knockdown ILK expression. Lipid-specific dyes were used to determine the TG content in LD. The genetic expression pattern of ILK, pro-inflammatory cytokines (MCP1, IL6), adipogenesis (PPARγ, Leptin), thermogenesis (UCP1), proliferation (PCNA), lipid metabolism (FASN, HSL, ATGL), and metabolite transporters (FABP4, FAT, AQP7) were detected using quantitative PCR. Cytoskeletal actin polymerization was detected by confocal microscopy. Immunoblotting was performed to detect INTB1 phosphorylation at Thr788/9 and ILK activity as phosphorylation levels of protein kinase B (AKT) in Ser473 and glycogen synthase kinase 3β (GSK3β) at Ser9. TF was intraperitoneally administered once per day to wildtype and ILK knockdown mice (cKDILK) challenged with a high-fat diet (HFD) or control diet (STD) for 2 weeks. Body and WAT weight gains were compared. The expression of ILK and other markers was determined in the visceral epididymal (epi) and inguinal subcutaneous (sc) WAT. Results TF reduced TG content and the expression of adipogenesis markers and transporters in adipocytes, while UCP-1 expression was increased and the expression of lipases, cytokines or PCNA was not affected. Mechanistically, TF rapidly increased and faded the intracellular phosphorylation of INTB1 but not AKT or GSK3β. F-actin levels were rapidly decreased, and INTB1 blockade avoided the TF effect. After 24 h, ILK expression and phosphorylation rates of AKT and GSK3β were upregulated, while ILK silencing increased TG content. INTB1 blockade and ILK silencing avoided TF effects on the TG content and the transcriptional expression of PPARγ and UCP1. In HFD-challenged mice, the systemic administration of TF for several days reduced the weight gain on WAT depots. TF reduced adipogenesis and pro-inflammatory biomarkers and increased lipolysis markers HSL and FAT in epiWAT from HFD, while increased UCP1 in scWAT. In both WATs, TF upregulated ILK expression and activity, while no changes were observed in other tissues. In HFD-fed cKDILK, the blunted ILK in epiWAT worsened weight gain and avoided the anti-obesogenic effect of in vivo TF administration. Conclusions ILK downregulation in WAT can be considered a biomarker of obesity establishment. Via an INTB1-ILK axis, TF restores malfunctioning hypertrophied WAT by changing the expression of adipocyte-related genes, increasing ILK expression and activity, and reducing TG storage. TF prevents obesity, a property to be added to its anticoagulant and cardiovascular protective advantages.

Abstract Aggressive behavior of bottlenose dolphins (Tursiops truncatus) towards conspecifics is widely described, but they have also often been reported attacking and killing harbour porpoises (Phocoena phocoena) around the world. However, very few reports exist of aggressive interactions between bottlenose dolphins and other cetacean species. Here, we provide the first evidence that bottlenose dolphins in the western Mediterranean exhibit aggressive behavior towards both striped dolphins (Stenella coeruleoalba) and Risso’s dolphins (Grampus griseus). Necropsies and visual examination of stranded striped (14) and Risso’s (2) dolphins showed numerous lesions (external rake marks and different bone fractures or internal organ damage by blunt trauma). Indicatively, these lessons matched the inter-tooth distance and features of bottlenose dolphins. In all instances, these traumatic interactions were presumed to be the leading cause of the death. We discuss how habitat changes, dietary shifts, and/or human colonization of marine areas may be promoting these interactions.

Abstract Background The incidence of non-AIDS defining cancer (NADC) is higher in people living with HIV (PLWH) than in the general population, and it is already one of the leading causes of death in the HIV-infected population. It is estimated that the situation will be aggravated by the progressive aging of PLWH. Early diagnosis through intensive cancer screening may improve the ability for therapeutic interventions and could be critical in reducing mortality, but it might also increase expenditure and harms associated with adverse events. The aim of this study is to evaluate an enhanced screening program for early diagnosis of cancer in PLWH compared to standard practice. The specific objectives are (1) to compare the frequency of cancer diagnosed at an early stage, (2) to analyze safety of the enhanced program: adverse events and unnecessary interventions, (3) to analyze the cost-utility of the program, and (4) to estimate the overall and site-specific incidence of NADC in PLWH. Methods We will conduct a multicenter, non-blinded, randomized, controlled trial, comparing two parallel arms: conventional vs enhanced screening. Data will be recorded in an electronic data collection notebook. Conventional intervention group will follow the standard of care screening in the participating centers, according to the European AIDS Clinical Society recommendations, and the enhanced intervention group will follow an expanded screening aimed to early detection of lung, liver, anal, cervical, breast, prostate, colorectal, and skin cancer. The trial will be conducted within the framework of the Spanish AIDS Research Network Cohort (CoRIS). Discussion The trial will evaluate the efficacy, safety, and efficiency of an enhanced screening program for the early diagnosis of cancer in HIV patients compared to standard of care practice. The information provided will be relevant since there are currently no studies on expanded cancer screening strategies in patients with HIV, and available data estimating cost effectiveness or cost-utility of such as programs are scarce. An enhanced program for NADC screening in patients with HIV could lead to early diagnosis and improve the prognosis of these patients, with an acceptable rate of unnecessary interventions, but it is critical to demonstrate that the benefits clearly outweigh the harms, before the strategy could be implemented. Trial registration ClinicalTrials.gov NCT04735445. Registered on 25 June 2019

Abstract Anecdotal evidence suggests that community infection control measures during the COVID-19 outbreak have modified the number and natural history of acute surgical inflammatory processes (ASIP—appendicitis, cholecystitis, diverticulitis and perianal abscesses) admissions. This study aims to evaluate the impact of the COVID-19 pandemic on the presentation and treatment ASIP and quantify the effect of COVID-19 infection on the outcomes of ASIP patients. This was a multicentre, comparative study, whereby ASIP cases from 2019, 2020 and 2021 (March 14th to May 2nd) were analyzed. Data regarding patient and disease characteristics as well as outcomes, were collected from sixteen centres in Madrid, and one in Seville (Spain). The number of patients treated for ASIP in 2019 was 822 compared to 521 in 2020 and 835 in 2021. This 1/3rd reduction occurs mainly in patients with mild cases, while the number of severe cases was similar. Surgical standards suffered a step back during the first wave: Lower laparoscopic approach and longer length of stay. We also found a more conservative approach to the patients this year, non-justified by clinical circumstances. Luckily these standards improved again in 2021. The positive COVID-19 status itself did not have a direct impact on mortality. Strikingly, none of the 33 surgically treated COVID positive patients during both years died postoperatively. This is an interesting finding which, if confirmed through future research with a larger sample size of COVID-19 positive patients, can expedite the recovery phase of acute surgical services.

In this paper the effect of different organosepiolites on PET matrix was evaluated through the analyses of Melt Flow Index (MFI) and Intrinsic Viscosity (IV) of the nanocomposites. PET/sepiolite nanocomposites were produced through a two-stage process. The masterbatch production was done in a melt compounding extruder, and then these were taken to an injection machine, where different specimens were obtained for characterization purposes. Two types of organomodifiers were tested, silanes in one hand and a quaternary ammonium salt on the other. Thermal analyses were done to determine thermal stability of the organomodifiers. Then, different experiments were carried out increasing the concentration of coupling agents to analyse its effect on PET matrix degradation. As results indicate a high degree of degradation of the nanocomposites matrix, pyromellitic dianhydride (PMDA) was added as chain extender to react with PET molecular chains, with the aim of increasing its molecular weight (Mw).

Introduction: Orofacial and cervical pain are a frequent reason for neurology consultations and may be due to multiple pathological processes. These include Eagle syndrome (ES), a very rare entity whose origin is attributed to calcification of the stylohyoid ligament or elongation of the temporal styloid process. We present a series of five patients diagnosed with ES. Methods: We describe the demographic and clinical characteristics and response to treatment of 5 patients who attended the headache units of 2 tertiary hospitals for symptoms compatible with Eagle syndrome. Results: The patients were 3 men and 2 women aged between 24 and 51, presenting dull, intense pain, predominantly in the inner ear and the ipsilateral tonsillar fossa. All patients had chronic, continuous pain in the temporal region, with exacerbations triggered by swallowing. Four patients had previously consulted several specialists at otorhinolaryngology departments; one had been prescribed antibiotics for suspected Eustachian tube inflammation. In all cases, the palpation of the tonsillar fossa was painful. Computed tomography scans revealed an elongation of the styloid process and/or calcification of the stylohyoid ligament in 3 patients. Four patients improved with neuromodulatory therapy (duloxetine, gabapentin, pregabalin) and only one required surgical excision of the styloid process. Conclusions: Eagle syndrome is a rare and possibly underdiagnosed cause of craniofacial pain. We present 5 new cases that exemplify both the symptoms and the potential treatments of this entity. Resumen: Objetivos: El dolor orofacial y cervical es un motivo de consulta frecuente, que puede deberse a múltiples procesos patológicos. Entre ellos se encuentra el síndrome de Eagle, entidad muy infrecuente cuyo origen se atribuye a una osificación del ligamento estilohioideo o una elongación de la apófisis estiloides. Presentamos una serie de cinco pacientes con dicho diagnóstico. Material y métodos: Se describen las características demográficas y clínicas de cinco pacientes atendidos en las Unidad de Cefaleas de dos hospitales terciarios por un cuadro compatible con síndrome de Eagle, y su respuesta a distintos tratamientos. Resultados: Se trata de 3 varones y 2 mujeres, de entre 24 y 51 años, con dolor de localización predominante en un oído y la región amigdalina ipsilateral, de cualidad sorda y de gran intensidad. En todos ellos el patrón temporal era crónico y continuo, con exacerbaciones desencadenadas por la deglución. Cuatro pacientes habían realizado múltiples consultas en servicios de otorrinolaringología, y uno de ellos había recibido tratamiento antibiótico ante la sospecha de tubaritis. En todos los casos la palpación de la fosa amigdalina resultó dolorosa. En tres de los pacientes se demostró elongación de la apófisis estiloides y/o calcificación del ligamento estilohioideo mediante tomografía computarizada. Cuatro mejoraron con tratamiento neuromodulador (duloxetina, gabapentina, pregabalina) y sólo uno precisó cirugía con escisión de la apófisis estiloides. Conclusiones: El síndrome de Eagle es una causa de dolor cráneo-facial poco frecuente, y posiblemente infradiagnosticada. Aportamos cinco nuevos casos que permiten delimitar tanto la semiología como los posibles tratamientos.

Introduction The concept of trema refers to an initial phase in the psychotic process that is characterized by intense anguish, an experience of hostility and a feeling of imminent catastrophe. This situation engenders in the patient a sensation of being in a tunnel than can only lead to something terrible but ineffable. Objectives To illustrate the incipient phase of psychotic disorder though the presentation of a case. Methods A presentation of a clinical case. Results A 29-year-old man attends the emergency department due to anxiety of one moth of evolution, that had debuted after a stressful event in the patient’s life such as loss of employment. He suffered from intense morning-predominance anguish, depersonalization episodes, insomnia, hallucinosis, cognitive blocks that occasioned him great anxiety and apragmatic behaviors. Besides, he had language alteration and autolytic ideation with previous autolytic gestures. After evaluation, he was diagnosed with psychotic episode. He was hospitalized, and treatment with olanzapine and lorazepam was started. Conclusions With the exhibition of this case, we intended to point up the importance of a differential diagnosis with different disorders marked by anxiety as the main symptom. In our case, panic disorder should be taken in account as a differential diagnosis. Furthermore, as the evidence shows, the identification of prodromic phases in schizophrenia allows an early diagnosis and early intervention, improving the prognosis. Disclosure No significant relationships.

Introduction The coronavirus disease 2019 (COVID-19) pandemic has had a profound worldwide impact on health. Acute Confusional Syndrome (ACS) is the most common neuropsychiatric complication in COVID-19 infection. Objectives Describe the characteristics of the admited patients attended by the liaison psychiatry service for acute confusional syndrome during the COVID 19 pandemic. Sociodemographical and clinical variables were descrived. Methods We conducted an observational, descriptive study. All patients attended by the liaison psychiatry service of Hospital del Mar, between February and April 2020, with ACS diagnosis were included. Results We included 62 patients with acute confusional syndrom; 35 were men (56.5%), and mean age was 71.71 years (standard deviation [SD]:11.345). The mean duration of admision stay was 41.19 days [SD: 38.039]. The mean number of consultations carried out was 6.5 [SD: 5.422]. 52.5% of our sample of our sample had confusional symptoms for 8 days. 50 patients presented complications during admission (80.6%), of which 43 patients developed infectious complications (69.4%). 59 patients had a history of chronic diseases (95.2%). 54 patiens (88.5%) had potencial risk factors associated with acute confusional syndrome including: isolation in 24 (39.3%), active infection in 46 (74.2%), hypoxemia in 25 (40.3%), previous cognitive impairment in 15 (24.6%) Conclusions Acute Confusional Syndrome mainly affects people with risk factors such as isolation, active infection and hypoxemia (which in turn are symptoms of Covid-19). Disclosure No significant relationships.

Introduction Paediatric and adult psychiatric emergency department (ED) visits decreased during the initial COVID-19 pandemic outbreak. Long-term consequences of the pandemic will include increases in mental healthcare needs especially among especially vulnerable groups such as children and adolescents. Objectives This study examined changes in the number of overall and diagnosis-specific mental health ED visits among patients aged

Introduction Coronavirus Disease 19 (COVID-19) was declared a pandemic by the World Health Organization (WHO) in March 2020. Since the outbreak, neuropsychiatric presentations such as delirium have been developing. Objectives Our aim is to describe sociodemographic and clinical differences between inpatients cursing with Acute Confusional Syndrome (ACS) with and without COVID-19 pneumonia. Methods This is an observational-descriptive study. All patients attended by the liaison psychiatry service of Hospital del Mar, between February and April 2020, with ACS diagnosis were included. The sample was divided in 2 groups (with and without COVID-19 pneumonia). Sociodemographic and clinical variables including sex, age, previous somatic or psychiatric history, ACS risk factors, ACS subtype and pharmacological treatment were compared. Chi-square and U Mann Whitney tests were used. Results The total sample was 62 patients. 43.5% were women with a mean age of 71,7 (SD 11,3). Covid pneumonia group included 26 patients. There was a higher percentage of Hypoxemia in Covid pneumonia patients (p

Introduction Gender is a factor influencing characteristics of substance use disorders. The Covid-19 pandemic has had a great impact in all areas of society, meaning a context of exceptionality in this population. Usually the male population represents a greater number of patients in general samples, so the descriptive characteristics of a global sample may not be representative in the case of women. Objectives - Identify if there are changes in the main substance of psychoactive substance use during the Covid-19 pandemic. - Identify possible divergences in characteristics of the general sample with respect to the sample made up of women. Methods It will be used data collected in the database of patients in follow-up with the addiction consultation service in two periods of 6 months, one prior to the pandemic situation due to Covid-19 and another corresponding to same period in 2020. A descriptive analysis is carried out by applying chi-square statistic, performing the analysis by subgroups according to gender. Results 84.8% of total sample are men. Results show that there are no statistically significant differences between periods in main substance of consumption. Despite this, differential trends can be observed in the sample that correspond to women with respect to the global sample and that of men. Conclusions Taking into account the low number of women that make up the sample, the fact that differential trends are observed could indicate possible differences, which in case of increasing the sample size could acquire statistical significance and that this it would be specific to women subgroup. Disclosure No significant relationships.

Introduction COVID19 has brought several psychosocial stressors that are having an impact on global mental health. The impact of the pandemic on the incidence of First Episode of Psychosis (FEP) is not clear. Objectives To describe the clinical and sociodemographic characteristics of FEP patients diagnosed since the onset of the COVID19 pandemic and compare them with the equivalent period of the previous year. Methods We included all FEP patients attended at Parc de Salut Mar (Barcelona, Spain) from March 14, 2020 (when the state of emergency in Spain began) to December 31, 2020 with the same period of 2019. We assessed sociodemographic variables, duration of untreated psychosis (DUP), cannabis and alcohol use, psychiatric diagnosis, and psychiatric symptom scales. We performed a univariate analysis between the groups using U-Mann Whitney for continuous variables and Chi-Square for qualitative variables. Results A total of 20 FEP patients were diagnosed in each period. No differences were found in sociodemographic variables, scales scores or DUP. During COVID19 period there was a smaller proportion of cannabis users (60% vs 90%; p=0.028) and a tendency of lower weekly consumption (14.44 vs 16.42; p=0.096). There were more cases of BPD (25% vs 5%; p=0.077) and less of affective psychosis (0% vs 25%; 0.017). Conclusions During the COVID-19 pandemic we did not find an increase of FEP or more severe clinical presentations. However, we identified differences in the type of FEP that could be related to the psychosocial stressors of this time. Disclosure No significant relationships.

Introduction Acute Confusional Syndrome (ACS) is the most common neuropsychiatric complication in COVID-19 infection. Its management is still a challenge because the data and recommendations based on the evidence are limited. Objectives To describe the differential characteristics in the management of ACS in patients with COVID-19 pneumonia compared to ACS secondary to other causes. Methods We present a descriptive study that is has been carried out in 62 patients with ACS (26 of them diagnosed with COVID 19 pneumonia), who have required assessment by the liaison psychiatry service of Hospital del Mar between February and April, 2020. The sample was divided in 2 groups (with and without COVID 19 pneumonia). Chi square and Fisher’s tests were used to comparisons. Results Dexmetomidine (26 vs 0) and olanzapine (13 vs 3) were significantly more frequently used in COVID-19 patients (p< 0 001). A greater number of different antipsychotic drugs were used in COVID 19 patients (2.40± 1 323 number of drugs), (p

Resumen: Introducción: La pandemia ocasionada por la aparición del SARS-CoV-2, ha transformado la práctica médica, y ha alterado gravemente la formación de los médicos residentes a nivel mundial. Desde la Sociedad Española de Neurología (SEN) se ha querido conocer el grado de repercusión que la COVID-19 ha tenido en el ámbito formativo entre los residentes de neurología. Método: Se realizó un estudio descriptivo transversal mediante el envío de una encuesta por email a todos los residentes de neurología miembros de dicha sociedad. Se incluyeron preguntas relativas a aspectos demográficos, actividad asistencial y repercusión a nivel formativo y personal durante la pandemia, así como su previsión sobre el futuro laboral «post-COVID». Resultados: De 422 encuestas, respondió un total de 152 (36%) residentes, 79 mujeres (52%) y 73 varones (48%). La distribución por año de residencia fue R4: 51 (33,6%), R3: 45 (29,6%), R2: 28 (18,4%) y R1: 28 (18,4%). La actividad de hospitalización se vio alterada en 139 (90,8%) casos. Consideraron que la situación afectaría negativamente a su formación 126 (82,8%) residentes, de los que 99 (64,7%) perdieron rotaciones no recuperables. Manifestaron deseo de alargar el periodo de residencia 101 (66%). Conclusiones: La pandemia ha tenido un gravísimo impacto en todo el sistema sanitario, siendo los médicos en formación uno de los colectivos más afectados. En los residentes de neurología ha provocado notables deficiencias de su actividad formativa y asistencial como consecuencia de la suspensión de rotaciones específicas. Un alto porcentaje manifestó deseo de ampliar el periodo de residencia. Abstract: Introduction: The COVID-19 pandemic has transformed medical practice and severely disrupted the training of medical residents worldwide. The Spanish Society of Neurology conducted a study to assess its impact on the training of neurology residents in Spain. Methods: We performed a descriptive, cross-sectional study through a survey distributed by e-mail to all neurology residents belonging to the Society. The survey included questions on demographic variables, care activity, and personal and educational impact of the pandemic, as well as respondents’ expectations for the future of their work in the post-pandemic era. Results: Of 422 surveys sent, we received a total of 152 responses (36%); 79 respondents (52%) were women and 73 (48%) were men. By year of residency, 51 respondents (33.6%) were in the fourth year, 45 (29.6%) in the third year, 28 (18.4%) in the second year, and 28 (18.4%) in the first year. A total of 139 respondents (90.8%) reported changes in hospital activity, and 126 (82.8%) considered the situation to have had a negative impact on their training, with 99 (64.7%) having lost non-recoverable rotations. Sixty-six percent of respondents (n=101) expressed a desire to extend their residency period. Conclusions: The pandemic has had an extremely severe impact on all areas of the health system, with trainee physicians being one of the most affected groups. Among neurology residents, the crisis has caused significant shortcomings in their training and clinical activities, through the suspension of specific rotations. A high percentage of respondents wished to extend the residency period.

Resumen: Objetivos: Desde el inicio de la pandemia por el virus SARS-CoV2 la Sociedad Española de Neurología (SEN) creó un registro de afectación neurológica para informar al neurólogo clínico. Las encefalopatías y encefalitis fueron una de las complicaciones más descritas. Analizamos las características de las mismas. Pacientes y métodos: Estudio descriptivo retrospectivo, observacional multicéntrico, de pacientes con sintomatología compatible con encefalitis o encefalopatía, introducidos en el Registro SEN COVID-19 desde el 17 de marzo hasta el 6 de junio de 2020. Resultados: Se han registrado 232 casos con síntomas neurológicos, 51 casos de encefalopatía/encefalitis (21,9%). Ningún paciente era trabajador sanitario. Los síndromes más frecuentes fueron: cuadro confusional leve-moderado (33%) y encefalopatía grave o coma (9,8%). El tiempo medio entre el inicio de la infección y la clínica neurológica fue de 8,02 días. Punción lumbar en el 60,8% de pacientes; solo hubo un caso con PCR positiva. Resonancia craneal en el 47% de los pacientes (alterada en el 7,8% de ellos). Se realizó electroencefalograma en el 41,3% de los casos (alterado en el 61,9% de los mismos). Conclusiones: Las encefalopatías y encefalitis son dos de las complicaciones más frecuentes descritas en el SEN COVID-19. Más de un tercio de los pacientes presentó un cuadro de síndrome confusional leve o moderado. El tiempo medio de aparición de la sintomatología neurológica desde el inicio de la infección fue de 8 días (hasta 24 h antes en mujeres que en hombres). El electroencefalograma fue la prueba más sensible en estos pacientes, encontrando muy pocos casos con alteraciones en las pruebas de neuroimagen. Todos los pacientes que recibieron tratamiento con bolos de corticoides o inmunoglobulinas tuvieron una evolución favorable. Abstract: Objectives: Since the beginning of the COVID-19 pandemic, the Spanish Society of Neurology has run a registry of patients with neurological involvement for the purpose of informing clinical neurologists. Encephalopathy and encephalitis were among the most frequently reported complications. In this study, we analyse the characteristics of these complications. Patients and methods: We conducted a retrospective, descriptive, observational, multicentre study of patients with symptoms compatible with encephalitis or encephalopathy, entered in the Spanish Society of Neurology's COVID-19 Registry from 17 March to 6 June 2020. Results: A total of 232 patients with neurological symptoms were registered, including 51 cases of encephalopathy or encephalitis (21.9%). None of these patients were healthcare professionals. The most frequent syndromes were mild or moderate confusion (33%) and severe encephalopathy or coma (9.8%). The mean time between onset of infection and onset of neurological symptoms was 8.02 days. Lumbar puncture was performed in 60.8% of patients, with positive PCR results for SARS-CoV-2 in only one case. Brain MRI studies were performed in 47% of patients, with alterations detected in 7.8% of these. EEG studies were performed in 41.3% of cases, detecting alterations in 61.9%. Conclusions: Encephalopathy and encephalitis are among the complications most frequently reported in the registry. More than one-third of patients presented mild or moderate confusional syndrome. The mean time from onset of infection to onset of neurological symptoms was 8 days (up to 24 hours earlier in women than in men). EEG was the most sensitive test in these patients, with very few cases presenting alterations in neuroimaging studies. All patients treated with boluses of corticosteroids or immunoglobulins progressed favourably.

Objectives: Since the beginning of the COVID-19 pandemic, the Spanish Society of Neurology has run a registry of patients with neurological involvement for the purpose of informing clinical neurologists. Encephalopathy and encephalitis were among the most frequently reported complications. In this study, we analyse the characteristics of these complications. Patients and methods: We conducted a retrospective, descriptive, observational, multicentre study of patients with symptoms compatible with encephalitis or encephalopathy, entered in the Spanish Society of Neurology's COVID-19 Registry from 17 March to 6 June 2020. Results: A total of 232 patients with neurological symptoms were registered, including 51 cases of encephalopathy or encephalitis (21.9%). None of these patients were healthcare professionals. The most frequent syndromes were mild or moderate confusion (33%) and severe encephalopathy or coma (9.8%). The mean time between onset of infection and onset of neurological symptoms was 8.02 days. Lumbar puncture was performed in 60.8% of patients, with positive PCR results for SARS-CoV-2 in only one case. Brain MRI studies were performed in 47% of patients, with alterations detected in 7.8% of these. EEG studies were performed in 41.3% of cases, detecting alterations in 61.9%. Conclusions: Encephalopathy and encephalitis are among the complications most frequently reported in the registry. More than one-third of patients presented mild or moderate confusional syndrome. The mean time from onset of infection to onset of neurological symptoms was 8 days (up to 24 hours earlier in women than in men). EEG was the most sensitive test in these patients, with very few cases presenting alterations in neuroimaging studies. All patients treated with boluses of corticosteroids or immunoglobulins progressed favourably. Resumen: Objetivos: Desde el inicio de la pandemia por el virus SARS-CoV2 la Sociedad Española de Neurología (SEN) creó un registro de afectación neurológica para informar al neurólogo clínico. Las encefalopatías y encefalitis fueron una de las complicaciones más descritas. Analizamos las características de las mismas. Pacientes y métodos: Estudio descriptivo retrospectivo, observacional multicéntrico, de pacientes con sintomatología compatible con encefalitis o encefalopatía, introducidos en el Registro SEN COVID-19 desde el 17 de marzo hasta el 6 de junio de 2020. Resultados: Se han registrado 232 casos con síntomas neurológicos, 51 casos de encefalopatía/encefalitis (21,9%). Ningún paciente era trabajador sanitario. Los síndromes más frecuentes fueron: cuadro confusional leve-moderado (33%) y encefalopatía grave o coma (9,8%). El tiempo medio entre el inicio de la infección y la clínica neurológica fue de 8,02 días. Punción lumbar en el 60,8% de pacientes; solo hubo un caso con PCR positiva. Resonancia craneal en el 47% de los pacientes (alterada en el 7,8% de ellos). Se realizó electroencefalograma en el 41,3% de los casos (alterado en el 61,9% de los mismos). Conclusiones: Las encefalopatías y encefalitis son dos de las complicaciones más frecuentes descritas en el SEN COVID-19. Más de un tercio de los pacientes presentó un cuadro de síndrome confusional leve o moderado. El tiempo medio de aparición de la sintomatología neurológica desde el inicio de la infección fue de 8 días (hasta 24 h antes en mujeres que en hombres). El electroencefalograma fue la prueba más sensible en estos pacientes, encontrando muy pocos casos con alteraciones en las pruebas de neuroimagen. Todos los pacientes que recibieron tratamiento con bolos de corticoides o inmunoglobulinas tuvieron una evolución favorable.

Resumen: Introducción: La epilepsia es una enfermedad prevalente en países en vías de desarrollo debido al mayor número de causas que pueden producirla, al menos duplicándose tanto incidencia como prevalencia en comparación con nuestro medio. Además, existe una gran estigmatización y los medios para su manejo son limitados. Material y métodos: Estudio observacional descriptivo mediante la realización de un cuestionario a profesionales sanitarios de 3 hospitales de Camerún, interrogando sobre factores relacionados con el manejo de la epilepsia, en diciembre de 2016. Se presentan los datos como media o porcentaje. Resultados: Participaron 38 profesionales sanitarios, de los cuales el 42,1% eran mujeres, con una edad media de 40,1 años (rango 22-62). Respecto a la causa de la enfermedad un 68,4% la considera psiquiátrica, 34,2% degenerativa, 28,9% hereditaria y 21,1% secundaria a una infección. En cuanto al manejo un 23,7% consideraba suficiente la anamnesis para llegar al diagnóstico. Solo un 60,5% consideraba la historia importante en el diagnóstico, 52,6% consideraba necesario un EEG, un 28,9% creía importantes las pruebas de laboratorio y un 13,2% la neuroimagen. Durante el embarazo solo un 36,8% considera importante asociar ácido fólico, solo el 65,8% cree que hay que mantener el tratamiento y solo un 39,5% creía recomendable la lactancia. Acerca del conocimiento de antiepilépticos, el número medio de fármacos conocido era de 2, siendo el más conocido el fenobarbital (81,6%) seguido de carbamacepina (55,3%) y ácido valproico (28,9%). Conclusiones: La educación y la mejor información sobre la enfermedad, su diagnóstico y las opciones de manejo son necesarias en los profesionales sanitarios para optimizar el manejo y con ello la calidad de vida de los pacientes. Abstract: Introduction: Epilepsy is especially prevalent in developing countries: incidence and prevalence rates are at least twice as high as in our setting. Epilepsy is also highly stigmatised, and few resources are available for its management. Material and methods: We performed a descriptive observational study in December 2016, distributing a questionnaire on epilepsy management to healthcare professionals from 3 different hospitals in Cameroon. Data are presented as means or percentages. Results: Thirty-eight healthcare providers participated in the survey; 42.1% were female and mean age was 40.1 years (range, 22-62). Regarding the causes of epilepsy, 68.4% considered it a psychiatric condition, 34.2% a degenerative disease, 28.9% a hereditary condition, and 21.1% secondary to infection. In terms of management, 23.7% considered that thorough clinical history is sufficient to establish a diagnosis. Only 60.5% considered the clinical interview to be important for diagnosis, 52.6% considered EEG to be necessary, and 28.9% considered laboratory analyses to be important. Only 13.2% mentioned neuroimaging. In the treatment of pregnant women, 36.8% recommended folic acid supplementation, 65.8% believed antiepileptic treatment should be maintained, and only 39.5% recommended breastfeeding. Concerning treatment, the participants knew a mean of 2 antiepileptic drugs: phenobarbital was the best known (81.6%), followed by carbamazepine (55.3%) and valproic acid (28.9%). Conclusions: There is a need among healthcare professionals for education and information on the disease, its diagnosis, and management options, in order to optimise management and consequently improve patients’ quality of life.

Resumen: Introducción: El pensamiento catastrófico (PC) hace referencia a un tipo de respuesta cognitiva y emocional negativa ante el dolor y se considera que contribuye a su cronificación. Pretendemos evaluar su presencia en una población de pacientes migrañosos. Métodos: Pacientes atendidos en una unidad de cefaleas de un hospital terciario (enero-junio de 2015). Se recogieron datos sociodemográficos y características de la migraña. Se midió el PC mediante la versión española de la Pain Catastrophizing Scale (PCS). Se comparó la presencia de PC en pacientes con migraña crónica y episódica y su correlación con las medidas de impacto (Escala HIT-6), de depresión y ansiedad (Escala Hospitalaria de Ansiedad y Depresión [HADS]) y la presencia de uso excesivo de medicación. Resultados: Se incluyeron 96 pacientes (16 varones y 80 mujeres). Sesenta y siete (69,8%) con migraña crónica y 29 (30,2%) con migraña episódica. El 85,4% presentó un impacto de la migraña al menos moderado (HIT-6 ≥ 56), el 24% superó el punto de corte para la ansiedad y el 9,4% para depresión. El 34,4% de la muestra superó el punto de corte de la PCS. En el grupo de pacientes con PC, mayor puntuación en la escala HADS-ansiedad (p

Introduction: Catastrophic thought refers to a negative cognitive and emotional response to pain, and is thought to contribute to pain chronification. We aimed to evaluate pain catastrophising (PC) in a population of patients with migraine. Methods: We collected sociodemographic data and clinical data on migraine from patients attended at a tertiary hospital headache unit between January and June 2015. PC was measured with the Spanish-language version of the Pain Catastrophizing Scale (PCS). We compared presence of PC in patients with episodic and chronic migraine, and its correlation with clinical impact (measured by the Headache Impact Test-6 [HIT-6] scale), comorbid depression and anxiety (measured with the Hospital Anxiety and Depression Scale [HADS]), and the presence of medication overuse. Results: The study included 96 patients (16 men and 80 women); 67 (69.8%) were diagnosed with chronic migraine and 29 (30.2%) with episodic migraine. Migraine impact was at least moderate (HIT-6 ≥ 56) in 85.4% of cases, and 24% exceeded the cut-off point for anxiety and 9.4% for depression. A total of 34.4% presented PC. Patients with chronic migraine scored higher than those with episodic symptoms on the HADS for anxiety (P

Introduction: Epilepsy is especially prevalent in developing countries: incidence and prevalence rates are at least twice as high as in our setting. Epilepsy is also highly stigmatised, and few resources are available for its management. Material and methods: We performed a descriptive observational study in December 2016, distributing a questionnaire on epilepsy management to healthcare professionals from 3 different hospitals in Cameroon. Data are presented as means or percentages. Results: Thirty-eight healthcare providers participated in the survey; 42.1% were female and mean age was 40.1 years (range, 22-62). Regarding the causes of epilepsy, 68.4% considered it a psychiatric condition, 34.2% a degenerative disease, 28.9% a hereditary condition, and 21.1% secondary to infection. In terms of management, 23.7% considered that thorough clinical history is sufficient to establish a diagnosis. Only 60.5% considered the clinical interview to be important for diagnosis, 52.6% considered EEG to be necessary, and 28.9% considered laboratory analyses to be important. Only 13.2% mentioned neuroimaging. In the treatment of pregnant women, 36.8% recommended folic acid supplementation, 65.8% believed antiepileptic treatment should be maintained, and only 39.5% recommended breastfeeding. Concerning treatment, the participants knew a mean of 2 antiepileptic drugs: phenobarbital was the best known (81.6%), followed by carbamazepine (55.3%) and valproic acid (28.9%). Conclusions: There is a need among healthcare professionals for education and information on the disease, its diagnosis, and management options, in order to optimise management and consequently improve patients’ quality of life. Resumen: Introducción: La epilepsia es una enfermedad prevalente en países en vías de desarrollo debido al mayor número de causas que pueden producirla, al menos duplicándose tanto incidencia como prevalencia en comparación con nuestro medio. Además, existe una gran estigmatización y los medios para su manejo son limitados. Material y métodos: Estudio observacional descriptivo mediante la realización de un cuestionario a profesionales sanitarios de 3 hospitales de Camerún, interrogando sobre factores relacionados con el manejo de la epilepsia, en diciembre de 2016. Se presentan los datos como media o porcentaje. Resultados: Participaron 38 profesionales sanitarios, de los cuales 42,1% eran mujeres, con una edad media de 40,1 años (rango 22-62). Respecto a la causa de la enfermedad, un 68,4% la considera psiquiátrica, 34,2% degenerativa, 28,9% hereditaria y 21,1% secundaria a una infección. En cuanto al manejo, un 23,7% consideraba suficiente la anamnesis para llegar al diagnóstico. Sólo un 60,5% consideraba la historia importante en el diagnóstico, 52,6% consideraba necesario un EEG, un 28,9% creía importantes las pruebas de laboratorio y un 13,2% la neuroimagen. Durante el embarazo, sólo un 36,8% considera importante asociar ácido fólico, sólo el 65,8% cree que hay que mantener el tratamiento y sólo un 39,5% creía recomendable la lactancia. Acerca del conocimiento de antiepilépticos, el número medio de fármacos conocido era de 2, siendo el más conocido el fenobarbital (81,6%) seguido de carbamacepina (55,3%) y ácido valproico (28,9%). Conclusiones: La educación y la mejor información sobre la enfermedad, su diagnóstico y las opciones de manejo son necesarias en los profesionales sanitarios para optimizar el manejo y con ello la calidad de vida de los pacientes.

Abstract The usefulness of local collagenase in therapeutic approaches to solid tumors has been tested recently. In this study, we evaluate the safety and efficacy of intraperitoneal collagenase associated or not to mitomycin for treatment of colorectal peritoneal metastases in an experimental rat model. Using a fixed-dose procedure, we found that a dose of collagenase of 37 IU/mL administered for 15 min with a hyperthermia pump at 37.5 °C, both in isolation or associated to sequential treatment with intraperitoneal mitomycin, led to a macroscopic decrease in tumor volume as evaluated by the modified peritoneal cancer index (mPCI). Concerning the safety of the procedure, the animals showed no physiological or behavioral disorders during 8 weeks of follow-up. Local treatment for peritoneal metastases of colorectal origin with intraperitoneal collagenase has proved safe and effective in an experimental murine model. Therefore, the stroma-first approach by enzymatic breakdown of collagen from the tumor's extracellular matrix provides a new therapeutic target for colorectal peritoneal metastases.

The global water cycle involves water-mass transport on land, in the atmosphere, in the ocean, and among them. Quantification of such transport, especially its time evolution, is essential to identify the footprints of climate change, and it also helps to constrain and improve climatic models. In the ocean, net water-mass transport among the ocean basins is a key process, but it is currently a poorly estimated parameter. We propose a new methodology that incorporates the time-variable gravity observations from the Gravity Recovery and Climate Experiment (GRACE) satellite (2003–2016) to estimate the change in water content; this new approach also overcomes some fundamental limitations of existing methods. We show that the Pacific and Arctic oceans receive an average of 1916 (95 % confidence interval of [1812, 2021]) Gt per month (∼0.72±0.02 Sv) of excess freshwater from the atmosphere and the continents that is discharged into the Atlantic and Indian oceans, where net evaporation minus precipitation returns the water to complete the cycle. This is in contrast to previous GRACE-based studies, where the notion of a see-saw mass exchange between the Pacific and the Atlantic and Indian oceans has been reported. Seasonal climatology as well as the interannual variability of water-mass transport are also reported.

Resumen: Introducción: La infección por SARS-CoV-2 ha tenido un enorme impacto en los sistemas sanitarios. España, donde la cefalea constituye el motivo principal de consulta ambulatoria en Neurología, es uno de los países con más casos notificados. Objetivo: Conocer el impacto de la pandemia COVID-19 en las Unidades de Cefaleas en España y evaluar cómo imaginan el futuro de estas estructuras los neurólogos responsables. Métodos: Estudio transversal mediante encuesta online distribuida a los responsables de las Unidades, realizada durante la sexta semana del estado de alarma. Resultados: La tasa de respuesta fue del 74%, con participación de centros de diferentes características y de todas las Comunidades Autónomas. El 95,8% describió limitaciones en la actividad presencial, un 60,4% mantuvo la consulta presencial preferente y el 45,8% los procedimientos urgentes. En el 91,7% de los centros la actividad presencial cancelada se sustituyó por consulta telefónica. El 95,8% de los encuestados afirmó que empleará material de protección personal en el futuro y el 86% pretende incorporar en mayor medida la telemedicina. La mayoría prevé un incremento en las listas de espera (93,8% en primeras visitas, 89,6% en revisiones y 89,4% en procedimientos) y una peor situación clínica de los pacientes, pero solo un 15% cree que su estructura asistencial se verá debilitada. Conclusiones: Como consecuencia de la pandemia, la actividad asistencial e investigadora en cefaleas se ha reducido de manera notable. Esto pone de manifiesto la necesidad de un incremento de la oferta de telemedicina en nuestros centros en un futuro cercano. Abstract: Introduction: The COVID-19 pandemic has had a great impact on healthcare systems. Spain, where headache is the main reason for outpatient neurology consultation, is one of the countries with the most reported cases of the disease. Objective: This study aimed to analyse the impact of the COVID-19 pandemic on headache units in Spain and to evaluate how neurologists see the future of these units. Methods: We conducted a cross-sectional online survey of headache units during the sixth week of the state of alarm declared in Spain in response to the pandemic. Results: The response rate was 74%, with the participation of centres with different characteristics and from all Autonomous Communities of Spain. Limitations in face-to-face activity were reported by 95.8% of centres, with preferential face-to-face consultation being maintained in 60.4%, and urgent procedures in 45.8%. In 91.7% of centres, the cancelled face-to-face activity was replaced by telephone consultation. 95.8% of respondents stated that they would use personal protection equipment in the future, and 86% intended to increase the use of telemedicine. The majority foresaw an increase in waiting lists (93.8% for initial consultations, 89.6% for follow-up, and 89.4% for procedures) and a worse clinical situation for patients, but only 15% believed that their healthcare structures would be negatively affected in the future. Conclusions: As a consequence of the pandemic, headache care and research activity has reduced considerably. This demonstrates the need for an increase in the availability of telemedicine in our centres in the near future.